Hip fracture

A hip fracture is a break or crack in the upper part of the femur (thigh bone), close to where it meets the hip joint. Hip fractures are serious injuries, especially in older adults, and often require surgical intervention for proper healing and restoration of function.

Types

Hip fractures are categorized based on the location of the break:

1. Intracapsular Fractures:

   • Occur within the hip joint capsule.
   • Subtypes include femoral neck fractures and transcervical fractures.
   • More common in older adults and associated with a higher risk of complications such as avascular necrosis.

2. Extracapsular Fractures:

   • Occur outside the hip joint capsule.
   • Subtypes include intertrochanteric fractures and subtrochanteric fractures.
   • Often caused by high-energy trauma and may have better outcomes than intracapsular fractures.

Causes

Hip fractures most commonly occur due to:

• Falls: Especially in older adults, falls are the leading cause of hip fractures.
• Osteoporosis: Weakening of the bones due to age-related loss of bone density increases the risk of fractures.
• Trauma: High-energy trauma such as motor vehicle accidents or sports injuries can cause hip fractures in younger individuals.
• Pathological Conditions: Conditions such as bone tumors or metabolic disorders can weaken the bones and predispose to fractures.

Symptoms

Symptoms of a hip fracture may include:

• Severe pain in the hip or groin area, exacerbated by movement.
• Inability to bear weight on the affected leg.
• Swelling, bruising, or deformity around the hip joint.
• Shortening of the affected leg compared to the unaffected side.
• Inability to move the leg or hip joint.

Diagnosis

Diagnosis of a hip fracture involves:

1. Medical History: Reviewing the circumstances of the injury and any associated symptoms.
2. Physical Examination: Assessing the hip for tenderness, swelling, deformity, and range of motion.
3. Imaging Tests:
   • X-rays: Most commonly used to confirm the diagnosis and determine the location and severity of the fracture.
   • MRI or CT Scan: Occasionally used for more detailed evaluation, especially if the fracture is complex or there are concerns about associated injuries.

Treatment

Treatment of a hip fracture typically involves surgical intervention to stabilize the fracture and promote healing:

1. Surgery:

   • Internal Fixation: Metal screws, plates, or rods are used to hold the fractured bones together.
   • Hip Replacement (Arthroplasty): In cases of severe fractures or pre-existing arthritis, a portion of or the entire hip joint may be replaced with artificial implants.
   • Hemiarthroplasty: Partial hip replacement involving the replacement of the femoral head with a prosthesis while preserving the native acetabulum.

2. Non-Surgical Management:

   • In rare cases where surgery is not feasible due to the patient's overall health or preferences, conservative management may include traction, bed rest, and pain management.

Rehabilitation

Rehabilitation plays a crucial role in the recovery process following a hip fracture:

• Physical Therapy: Exercises to improve strength, range of motion, and mobility.
• Occupational Therapy: Assistance with activities of daily living and home modifications to facilitate independence.
• Gait Training: Learning proper walking techniques and using assistive devices such as walkers or canes as needed.

Complications

Complications of hip fractures may include:

• Delayed Healing: Especially in older adults or individuals with pre-existing medical conditions.
• Infection: Surgical site infections or urinary tract infections due to immobility.
• Blood Clots: Deep vein thrombosis (DVT) or pulmonary embolism (PE) due to reduced mobility.
• Pressure Sores: From prolonged bed rest or immobility.
• Muscle Weakness: Atrophy of the muscles surrounding the hip joint due to disuse.

Prevention

Preventive measures to reduce the risk of hip fractures include:

• Fall Prevention: Removing hazards in the home, using assistive devices, and participating in balance and strength training exercises.
• Osteoporosis Management: Regular exercise, adequate calcium and vitamin D intake, and medication therapy as appropriate.
• Safety Precautions: Wearing protective gear during sports activities and adhering to safety guidelines in occupational settings.

When to See a Doctor

Seek immediate medical attention if you suspect a hip fracture, especially if:

• There is severe pain or deformity in the hip area.
• The affected leg cannot bear weight.
• There is significant swelling, bruising, or tenderness around the hip joint.

Conclusion

Hip fractures are serious injuries that require prompt medical evaluation and appropriate treatment, often including surgical intervention. Rehabilitation and preventive measures play crucial roles in the recovery process and reducing the risk of future fractures. If you or a loved one experiences symptoms suggestive of a hip fracture, seek medical attention promptly for evaluation and management.